Sources of regional and center-level variability in survival and cost of care for congenital diaphragmatic hernia (CDH)

Abstract

PurposeEnormous variability in management and cost occurs in CDH care. The purpose of this study was to identify regional mortality and cost patterns underlying this variability. MethodsThis is a retrospective study of neonatal CDH patients at U.S. hospitals using data from the Pediatric Health Information System (PHIS) database (2015–2018). Patients were risk-stratified using CDH Study Group predicted survival (CDHSG-PS), and mortality and costs were assessed by region (East, West, Mid-West, and South) and center. ResultsHigher mortality and extracorporeal life support (ECLS) rates were found in the Mid-West and South (p<0.0001). Higher mortality was seen with ECLS among low-volume centers in the South (p=0.007). When broken down by CHDSG-PS, higher severity patients had higher mortality in the Mid-West and South (p=0.038). Cost was significantly lower for high severity nonsurvivors than survivors ($244,005 vs $565,487, p=0.0008). The East spent more on high-severity patients with lower mortality compared to other regions, but also spent 3.5 times more on low severity nonsurvivors than survivors. Costs were higher at high-volume centers for low- and medium-severity patients, but all centers spent the same on high-severity patients. ConclusionCenter volume, region, and patient severity all contribute to the complex survival and cost disparities that exist in CDH care. Standardization of care may improve survival and reduce cost variability. Type of studyRetrospective database study. Level of evidenceLevel II